SPECIAL FEATURE
Consumer Devices for SoundBased Management of Tinnitus: Where’s the Evidence? By Devon Kulinski, BA, and Candice Manning, AuD, PhD
Sound therapy for tinnitus management refers to any use of sound with the intention of reducing a person’s perception of or reactions to tinnitus in a clinically meaningful way.1 This article outlines sound therapy as a treatment option for tinnitus and discusses products that are commercially available. We carefully consider consumers’ needs and compare them to the research evidence to help facilitate successful sound therapy intervention.
Sound Therapy: Then and Now The first publication on the use of sound therapy for the treatment of tinnitus dates back to 1821 when French physician Jean-Marc Itard described the use of a roaring fire, among other environmental sounds, to effectively mask the perception of the phantom ear noise.2 In lieu of a cure, Itard’s opinion on the role of the physician was to “make tinnitus less unbearable, especially from the point of view of sleep disturbance and ongoing worry.” Fast-forward almost two hundred years and this approach 4
TINNITUS TODAY SPRING 2019
is still widely accepted in current clinical practice. Unlike Itard, modern technology allows for the advent of innovative commercial products to deliver therapy for tinnitus sufferers. Instead of a roaring fire, sound generators can simulate soothing environmental sounds. Similarly, with the tap of a button smartphones easily enable users to listen to music, audiobooks, or apps with customizable sounds. Other approaches attempt to more accurately target the auditory system and the brain with the use of individually tailored sounds intended to create lasting effects even after the stimulus is turned off. These techniques advocate more than just transient management of the symptom. Some products report a sustained long-term reduction of psychoacoustic properties of tinnitus.3, 4 More products will make their way into the hands, and ears, of the general public. With most consumers paying out of pocket for these treatments, it is crucial to compare them against current standards of care. Customers and clinicians alike need quality research evidence to evaluate product efficacy. When it comes to commercial devices for sound-based tinnitus management…where is the evidence?
Clinical Practice Guidelines Before discussing commercial devices, we provide a brief overview of best practices for the clinical management of tinnitus. For a more in-depth look at clinical practice guidelines, please read Dr. James Henry’s featured piece in the Winter 2017 issue of Tinnitus Today entitled ”Tinnitus Management Based on Research Evidence.”5 It provides basic guidance for any person dealing with bothersome tinnitus. In the United States, the closest thing we have to a gold standard for the management of persistent, bothersome tinnitus is the American Academy of Otolaryngology—Head & Neck Surgery Foundation’s (AAOHNSF) “Clinical Practice Guideline: Tinnitus.”6 Part of the AAO-HNSF guideline assesses intervention techniques by giving a rating ranging from “strong recommendation for” to “strong recommendation against.” These ratings were determined on the basis of a systematic review of high-quality research evidence, which constitutes the highest form of validity in the scientific community.7 In the AAO-HNSF guideline, only education and counseling, hearing aid www.ATA.org
